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Excellence in nursing: myth or reality?

Sue Spencer looks at the recent report from the Patients Association on dignity of care in Wales. It states, like many reports before it, that older people are all too frequently ignored, neglected and overlooked in the care delivery lottery.

Older people should not spend their lives concerned about receiving poor care, nor should relatives have to be extra vigilant about the care their loved ones are receiving. The expectation should be that care is excellent and that the person receiving care will be provided with individual care assessment that recognises their specific needs and life story.

Needless to say, the stories I hear from those who often bend my ear about recent experiences of healthcare is that people are still treated as diseases or interventions; and that although information might be taken about previous experiences, anxieties and concerns, these bits of information are either ignored or overlooked.

Some wonder whether they are even documented and that asking the question is just a tick box exercise; ie, the question has been asked BUT the answer has gone no further and no one is really bothered. They are just concentrating their efforts on achieving outcomes rather than directing energy on to the process of care.

I don't have any answers to these questions, but what I can do is share my values and attitudes with those who might listen. I know that the delivery of healthcare in the second decade of the 21st century is a real challenge. Budgets have been cut, organisations redesigned yet again, and uncertainty and complexity are all around healthcare delivery.

I know listening to service users and responding to their experiences is the way forward but I am not sure that all those responsible for healthcare provision know how to capture this information. They certainly don't know how to respond constructively to those experiences. Why does it have to take extreme cases for the media to take any notice?

As I point out to student nurses, a story about exemplary nursing care, where communication was excellent and the care received second to none is unlikely to make the front page of the tabloid press - thus, it is always going to be the negative headlines that will be read.

Why don't we start letting people know about where care is excellent, where care is person centred and the family and carers feel involved? Why don't we let the world know about nurses doing the best they can and the positive experiences of healthcare services being developed and improved to meet the needs? We need to find ways of celebrating great care and we need to recognise where practitioners are working well together as a fully functioning team.

I am sure there are examples of great practice out there - innovative and exceptional practice - we just need to be encouraged to share them. My concern with the recent NHS reforms is that the word 'competition' might return us to a culture of secrecy, and that competition means that good practice and service improvements will be seen as a 'trade secret' and great ideas won't be shared - that would be real shame and potentially a real step backwards.